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Pusa, S., Baxter, R., Andersson, S., Fromme, E. K., Paladino, J. & Sandgren, A. (2024). Core competencies for serious illness conversations: an integrative systematic review. Journal of Palliative Care
Open this publication in new window or tab >>Core competencies for serious illness conversations: an integrative systematic review
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2024 (English)In: Journal of Palliative Care, ISSN 0825-8597Article in journal (Refereed) Epub ahead of print
Abstract [en]

Objective: The Serious Illness Care Program was developed to support goals and values discussions between seriously ill patients and their clinicians. The core competencies, that is, the essential clinical conversation skills that are described as requisite for effective serious illness conversations (SICs) in practice, have not yet been explicated. This integrative systematic review aimed to identify core competencies for SICs in the context of the Serious Illness Care Program. 

Methods: Articles published between January 2014 and March 2023 were identified in MEDLINE, PsycINFO, CINAHL, and PubMed databases. In total, 313 records underwent title and abstract screening, and 96 full-text articles were assessed for eligibility. The articles were critically appraised using the Joanna Briggs Institute Critical Appraisal Guidelines, and data were analyzed using thematic synthesis.

Results: In total, 53 articles were included. Clinicians' core competencies for SICs were described in 3 themes: conversation resources, intrapersonal capabilities, and interpersonal capabilities. Conversation resources included using the conversation guide as a tool, together with applying appropriate communication skills to support better communication. Intrapersonal capabilities included calibrating one's own attitudes and mindset as well as confidence and self-assurance to engage in SICs. Interpersonal capabilities focused on the clinician's ability to interact with patients and family members to foster a mutually trusting relationship, including empathetic communication with attention and adherence to patient and family members views, goals, needs, and preferences.

Conclusions: Clinicians need to efficiently combine conversation resources with intrapersonal and interpersonal skills to successfully conduct and interact in SICs.

Place, publisher, year, edition, pages
Sage Publications, 2024
Keywords
clinical competence; health communication; palliative care; serious illness care program; serious illness conversations; systematic review.
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-223027 (URN)10.1177/08258597241245022 (DOI)38557369 (PubMedID)2-s2.0-85189149661 (Scopus ID)
Funder
The Kamprad Family Foundation, 20210163
Available from: 2024-04-08 Created: 2024-04-08 Last updated: 2024-04-08
Andersson, S., Martinsson, L., Fürst, C. J. & Brännström, M. (2024). End-of-life discussions in residential care homes improves symptom control: a national register study. BMJ Supportive & Palliative Care, 14(e1), e1008-e1015
Open this publication in new window or tab >>End-of-life discussions in residential care homes improves symptom control: a national register study
2024 (English)In: BMJ Supportive & Palliative Care, ISSN 2045-435X, E-ISSN 2045-4368, Vol. 14, no e1, p. e1008-e1015Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In Europe, residential care homes (RCHs) rather than hospitals are the most common care facilities for the older adult and the place where most deaths occur in this age group. There is a lack of knowledge regarding end-of-life (EOL) discussions and how they correlate with symptoms and symptom relief.

OBJECTIVE: The aim was to examine the correlation between EOL discussions and symptom occurrence, symptom relief and prescriptions or PRN drugs against symptoms for care home residents.

METHODS: All expected deaths at RCHs from 1 October 2015 to 31 December 2016 and registered in the Swedish Register of Palliative Care were included. Univariate and multivariate logistic regression were used to compare the RCH residents, or their family members, who had received documented EOL discussions with a physician (the EOL discussion group) and the non-EOL discussion group.

RESULTS: The EOL discussion group (n=17 071) had a higher prevalence of pain, nausea, anxiety, death rattles and shortness of breath reported, compared with the non-EOL discussion group (n=4164). Those with symptoms were more often completely relieved and had more often been prescribed PRN drugs against that symptom in the EOL discussion group. All differences remained significant when adjusting for age, time living in unit and cause of death.

CONCLUSION: The results indicate that EOL discussions are correlated with higher prevalence of symptoms, but also with better symptom relief and prescription of symptom drugs PRN when symptomatic. A possible explanation for this is that the EOL discussion can work as an opportunity to discuss symptoms and treatment for symptom relief.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2024
Keywords
nursing home care, symptoms and symptom management
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-185343 (URN)10.1136/bmjspcare-2021-002983 (DOI)000727503800001 ()34162583 (PubMedID)2-s2.0-85108851122 (Scopus ID)
Available from: 2021-06-28 Created: 2021-06-28 Last updated: 2024-06-25Bibliographically approved
Granat, L., Andersson, S., Åberg, D., Hadziabdic, E. & Sandgren, A. (2024). Evaluation of the swedish self‐efficacy in palliative care scale and exploration of nurses' and physicians' self‐efficacy in swedish hospitals: a cross‐sectional study. Scandinavian Journal of Caring Sciences
Open this publication in new window or tab >>Evaluation of the swedish self‐efficacy in palliative care scale and exploration of nurses' and physicians' self‐efficacy in swedish hospitals: a cross‐sectional study
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2024 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: Previous research found that healthcare professionals had low preparedness for palliative care. Thus, it is necessary to explore healthcare professionals' self-efficacy. The Swedish Self-Efficacy in Palliative Care Scale (SEPC-SE) evaluates readiness in communication, patient management and multidisciplinary teamwork; however, it should be tested on a larger population. Furthermore, the constructs of the SEPC-SE should be compared to that of the original SEPC.

Aim: This study aimed to evaluate the consensus between the construct validity and reliability of the SEPC and the translated and adapted SEPC-SE. Furthermore, it aimed to describe and compare the self-efficacy of nurses and physicians in hospitals and explore the associated factors.

Methods: The nurses (n = 288) and physicians (n = 104) completed the SEPC-SE. Factor analysis with Cronbach's alpha evaluated validity and reliability, and an analysis using the Mann-Whitney U test compared self-efficacy and multiple linear regression-associated factors.

Results: The SEPC-SE revealed three factors with high reliability. Education or experience in specialised palliative care was minor, especially for nurses. Self-efficacy was highest in patient management (nurses, median [md] = 74.57, physicians md = 81.71, p = 0.010) and communication (nurses md = 69.88, physicians md = 77.00, p = 0.141) and lowest in multidisciplinary teamwork (nurses md = 52.44, physicians md = 62.88, p = 0.001). The strongest associations with self-efficacy were education at work and advanced homecare experiences. In addition, there were significant associations between years in the profession, male sex, physicians and university education.

Conclusion: The SEPC-SE is valid and reliable for measuring self-efficacy. Nurses had lower self-efficacy than physicians. Physicians were associated with higher self-efficacy and had more education and experience in palliative care settings, which may explain their levels of self-efficacy.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
construct validity, hospitals, nurses, palliative care, physicians, reliability, self-efficacy, SEPC scale
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-222333 (URN)10.1111/scs.13244 (DOI)2-s2.0-85187105443 (Scopus ID)
Available from: 2024-03-14 Created: 2024-03-14 Last updated: 2024-03-18
Brännström, M., Philipsson, J. & Andersson, S. (2024). Healthcare professionals' experiences of video consultations in palliative care in rural areas: an intervention study in community care. BMC Health Services Research, 24(1), Article ID 740.
Open this publication in new window or tab >>Healthcare professionals' experiences of video consultations in palliative care in rural areas: an intervention study in community care
2024 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 24, no 1, article id 740Article in journal (Refereed) Published
Abstract [en]

Background: The population is aging, leading to an increased need for palliative care and end-of-life care. There is a lack of research on the use of video consultations for knowledge transfer between specialist and general palliative care. The aim of this study was to describe healthcare professionals’ experiences of video consultations in palliative care in community homecare and nursing homes in rural areas.

Methods: Individual interviews (n = 11) were conducted with five community nurses, one occupational therapist, two specialist palliative nurses, and three specialist palliative care physicians. The data were analysed using reflexive thematic analysis.

Results: The analysis identified three themes: feeling comfortable with increased availability of specialist expertise; seeing each other facilitates communication; and being supported by physically present care professionals is essential.

Conclusion: HCPs suggest that video consultations are an effective way to increase access to specialist palliative care and provide more equal care to patients with palliative care needs in rural community care.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2024
Keywords
E-healt, End-of-life care, palliative care, Qualitative research, Rural care
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-226797 (URN)10.1186/s12913-024-11196-5 (DOI)38886714 (PubMedID)2-s2.0-85196098352 (Scopus ID)
Available from: 2024-06-20 Created: 2024-06-20 Last updated: 2024-06-24Bibliographically approved
Baxter, R., Pusa, S., Andersson, S. & Sandgren, A. (2024). Perils and payoffs for patients in serious illness conversations as described by physicians: a qualitative study. BMJ Open Quality, 13(2), Article ID e002734.
Open this publication in new window or tab >>Perils and payoffs for patients in serious illness conversations as described by physicians: a qualitative study
2024 (English)In: BMJ Open Quality, E-ISSN 2399-6641, Vol. 13, no 2, article id e002734Article in journal (Refereed) Published
Abstract [en]

Background: The Serious Illness Care Programme was developed to promote more, better and earlier serious illness conversations. Conversations about goals and values are associated with improved experiences and outcomes for seriously ill patients. Clinicians’ attitudes and beliefs are thought to influence the uptake and performance of serious illness conversations, yet little is known about how clinicians perceive the impact of these conversations on patients. This study aimed to explore physicians’ perceptions regarding the impact of serious illness conversations for patients.

Methods: The Serious Illness Care Programme was implemented as a quality improvement project in two hospitals in Southern Sweden. Focus group evaluation discussions were conducted with 14 physicians and inductive thematic analysis was undertaken.

Results: The results revealed that physicians considered potential perils and optimised potential payoffs for patients when engaging in serious illness conversations. Potential perils encompassed inappropriate timing, damaging emotions and shattering hopes. Potential payoffs included reflection time, secure space, and united understandings.

Conclusions: Physicians depicted a balance in evaluating the perils and payoffs of serious illness conversations for patients and recognised the interrelation of these possibilities through continual assessment and adjustment.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2024
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-225091 (URN)10.1136/bmjoq-2023-002734 (DOI)2-s2.0-85194129877 (Scopus ID)
Funder
The Kamprad Family Foundation, 20172014
Available from: 2024-05-27 Created: 2024-05-27 Last updated: 2024-06-03Bibliographically approved
Andersson, S., Granat, L., Baxter, R., Reimertz, H., Modéus, C., Pusa, S. & Sandgren, A. (2024). Translation, adaptation, and validation of the swedish serious illness conversation guide. Journal of Palliative Care, 39(1), 21-28
Open this publication in new window or tab >>Translation, adaptation, and validation of the swedish serious illness conversation guide
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2024 (English)In: Journal of Palliative Care, ISSN 0825-8597, Vol. 39, no 1, p. 21-28Article in journal (Refereed) Published
Abstract [en]

Objective: To translate and adapt the Serious Illness Conversation Guide for use within the Swedish healthcare setting and examine the validity and acceptability of the Swedish Serious Illness Conversation Guide.

Methods: Three rounds of cognitive interviews were conducted (T1-3); patients (T1 n = 11; T2 n = 10; T3 n = 8), family members (T1 n = 5; T2 n = 2; T3 n = 2), and healthcare professionals (T1 n = 6; T2 n = 6; T3 n = 5). The guide was iteratively adapted based on interview feedback, clinical experience, and the literature. The guide was tested on training days with physicians and nurses.

Results: The Swedish Serious Illness Conversation Guide was found to be useful in supporting serious illness conversations. Clinicians reported that some questions were emotionally challenging. Explicit questions about prognosis and timing were excluded. Instead, the dual approach of “hoping for the best and preparing for the worst” was used to explore patients’ thoughts about the future.

Conclusions: Patients, family members, and healthcare professionals found the Swedish Serious Illness Conversation Guide to be appropriate, sensitive, and responsive to their needs. The Swedish Serious Illness Conversation Guide may facilitate a more health-promoting approach to serious illness conversations. Further research is needed to understand the impact of these conversations on person-centered and goal-concordant care.

Place, publisher, year, edition, pages
Sage Publications, 2024
Keywords
health communication, palliative care, patients, serious illness conversation, translation, validation
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-216215 (URN)10.1177/08258597231210136 (DOI)37886797 (PubMedID)2-s2.0-85175310374 (Scopus ID)
Funder
The Kamprad Family Foundation, 20210163
Available from: 2023-11-06 Created: 2023-11-06 Last updated: 2024-01-09Bibliographically approved
Baxter, R., Pusa, S., Andersson, S., Fromme, E. K., Paladino, J. & Sandgren, A. (2023). Core elements of serious illness conversations: an integrative systematic review. BMJ Supportive & Palliative Care
Open this publication in new window or tab >>Core elements of serious illness conversations: an integrative systematic review
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2023 (English)In: BMJ Supportive & Palliative Care, ISSN 2045-435X, E-ISSN 2045-4368Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: Ariadne Labs' Serious Illness Care Program (SICP), inclusive of the Serious Illness Conversation Guide (SICG), has been adapted for use in a variety of settings and among diverse population groups. Explicating the core elements of serious illness conversations could support the inclusion or exclusion of certain components in future iterations of the programme and the guide.

Aim: This integrative systematic review aimed to identify and describe core elements of serious illness conversations in relation to the SICP and/or SICG.

Design: Literature published between 1 January 2014 and 20 March 2023 was searched in MEDLINE, PsycINFO, CINAHL and PubMed. All articles were evaluated using the Joanna Briggs Institute Critical Appraisal Guidelines. Data were analysed with thematic synthesis.

Results: A total of 64 articles met the inclusion criteria. Three themes were revealed: (1) serious illness conversations serve different functions that are reflected in how they are conveyed; (2) serious illness conversations endeavour to discover what matters to patients and (3) serious illness conversations seek to align what patients want in their life and care.

Conclusions: Core elements of serious illness conversations included explicating the intention, framing, expectations and directions for the conversation. This encompassed discussing current and possible trajectories with a view towards uncovering matters of importance to the patient as a person. Preferences and priorities could be used to inform future preparation and recommendations. Serious illness conversation elements could be adapted and altered depending on the intended purpose of the conversation.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2023
Keywords
Communication, End of life care, Hospital care, Quality of life, Psychological care, Supportive care
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:umu:diva-214330 (URN)10.1136/spcare-2023-004163 (DOI)001023721700001 ()37369576 (PubMedID)2-s2.0-85164331520 (Scopus ID)
Available from: 2023-09-11 Created: 2023-09-11 Last updated: 2024-03-14
Martinsson, L., Brännström, M. & Andersson, S. (2023). Symptom assessment in the dying: family members versus healthcare professionals. BMJ Supportive & Palliative Care
Open this publication in new window or tab >>Symptom assessment in the dying: family members versus healthcare professionals
2023 (English)In: BMJ Supportive & Palliative Care, ISSN 2045-435X, E-ISSN 2045-4368Article in journal (Refereed) Epub ahead of print
Abstract [en]

Objectives: Symptom management and support of the family members (FMs) are consideredessential aspects of palliative care. During end of life, patients are often not able to self-reportsymptoms. There is little knowledge in the literature of how healthcare professionals(HCPs) assess symptoms compared with FMs.The objective was to compare the assessment ofsymptoms and symptom relief during the final week of life between what was reported by FMsand what was reported by HCPs.

Methods: Data from the Swedish Register of Palliative Care from 2021 and 2022 were usedto compare congruity of the assessments by the FMs and by HCPs regarding occurrence and reliefof three symptoms (pain, anxiety and confusion), using Cohen’s kappa.

Results: A total of 1131 patients were included. The agreement between FMs and HCPs was poorfor occurrence of pain and confusion (kappa 0.25 and 0.16), but fair for occurrence of anxiety(kappa 0.30). When agreeing on a symptom being present, agreement on relief of thatsymptom was poor (kappa 0.04 for pain, 0.10 for anxiety and 0.01 for confusion). The trendwas that HCPs more often rated occurrence of pain and anxiety, less often occurrence ofconfusion and more often complete symptom relief compared with the FMs.

Conclusions: The views of FMs and HCPs of the patients’ symptoms differ in the end-of-life context, but both report important information and their symptom assessments should beconsidered both together and individually. More communication between HCPs and FMs couldprobably bridge some of these differences.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2023
Keywords
family members, healthcare professional, palliative care, symptom management
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-216845 (URN)10.1136/spcare-2023-004382 (DOI)37973205 (PubMedID)2-s2.0-85178282975 (Scopus ID)
Available from: 2023-11-17 Created: 2023-11-17 Last updated: 2023-12-12
Andersson, S. & Sandgren, A. (2022). Organizational readiness to implement the serious illness care program in hospital settings in Sweden. BMC Health Services Research, 22(1), Article ID 539.
Open this publication in new window or tab >>Organizational readiness to implement the serious illness care program in hospital settings in Sweden
2022 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 22, no 1, article id 539Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The Serious Illness Care Program (SICP) is a model developed for structured communication, identifying patients, and training physicians to use a structured guide for conversations with patients and family members. However, there is a lack of knowledge regarding the sustainable implementation of this conversation model. Therefore, the aim of this study was to identify barriers and enablers during the implementation of the SICP in hospital settings.

METHODS: The SICP was implemented at 20 units in two hospitals in Sweden. During the implementation process, seven individual interviews and two group interviews were conducted with seven facilitators (five physicians, one behavioral therapist, and one administrator). Data were analyzed using qualitative content analysis, first inductively, and then deductively using the organizational readiness for change as a theoretical framework.

RESULT: The analysis resulted in three factors acting as enablers and eight factors acting as enablers and/or barriers during the implementation of the SICP. The three factors considered as enablers were preliminaries, identifying patients, and facilitator's role. The eight factors considered as enablers and/or barriers were broad implementation, leadership, time, confidence, building foundation, motivation to work change, motivation for training in serious illness conversations, and attitudes.

CONCLUSION: This study indicates limited readiness to implement the SICP in hospital settings due to considerable variation in organizational contextual factors, change efficacy, and change commitment. The identified enablers and barriers for implementation of the SICP could guide and support future implementations to be sustainable over time.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2022
Keywords
Conversation, Implementation, Organization readiness for change, Palliative care, Qualitative, Serious illness, Serious illness program
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-216621 (URN)10.1186/s12913-022-07923-5 (DOI)000785607300011 ()35459204 (PubMedID)2-s2.0-85128729823 (Scopus ID)
Available from: 2023-11-14 Created: 2023-11-14 Last updated: 2023-11-14Bibliographically approved
Granat, L., Andersson, S., Hadziabdic, E., Brännström, M. & Sandgren, A. (2022). Translation, adaptation, and validation of the Self-efficacy in Palliative Care scale (SEPC) for use in Swedish healthcare settings. BMC Palliative Care, 21(1), Article ID 48.
Open this publication in new window or tab >>Translation, adaptation, and validation of the Self-efficacy in Palliative Care scale (SEPC) for use in Swedish healthcare settings
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2022 (English)In: BMC Palliative Care, E-ISSN 1472-684X, Vol. 21, no 1, article id 48Article in journal (Refereed) Published
Abstract [en]

Background: One challenge for healthcare professionals when delivering palliative care can be their lack of confidence. The Self-efficacy in Palliative Care Scale (SEPC) is considered a valid and reliable assessment scale to evaluate confidence when delivering palliative care. Currently, there is not a reliable instrument aimed to measure healthcare professionals’ confidence in palliative care in Swedish. Therefore, this study aimed to translate, culturally adapt, and validate the SEPC-scale for use in a Swedish healthcare context.

Methods: This study applied the World Health Organization’s (WHO) guidelines for translating and adapting instruments, using forward and back-translation, an expert panel, and cognitive interviews. Swedish experts in palliative care (n = 6) assessed the Swedish version of the SEPC-scale based on its relevance, understandability, clarity, and sensitivity on a Likert scale. Methods involved calculation of content validity index (CVI) with modified kappa statistics and cognitive interviewing with healthcare professionals (n = 10) according to the “think-aloud” method.

Results: Calculation of I-CVI (Item-CVI) showed that the Swedish SEPC-scale was considered relevant but needed some modifications to improve its understandability and clarity. The experts recognized an absence of precision in some items that affected clarity and understanding. Likewise, the healthcare professionals highlighted some challenges with understandability and clarity. They indicated that the scale was relevant, but a few items needed adjustment to fit a broader range of healthcare professionals. Items that referred to death and dying could be sensitive but were considered relevant.

Conclusions: The SEPC-scale is considered valid for use in Swedish healthcare practice, for a broad range of healthcare professionals, and for diagnoses other than cancer. This study shows that cultural adaptation is necessary for establishing relevance and enabling acceptance to various healthcare professionals and contexts in the target country.necessary for establishing relevance and enabling acceptance to various healthcare professionals and contexts in the target country.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2022
Keywords
Confdence, Healthcare professionals, Instrument, Palliative care, Self-efcacy, SEPC-scale, Validation
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-193907 (URN)10.1186/s12904-022-00940-5 (DOI)000781170600001 ()35410328 (PubMedID)2-s2.0-85128049591 (Scopus ID)
Funder
The Kamprad Family Foundation, 20172002
Available from: 2022-04-20 Created: 2022-04-20 Last updated: 2024-01-17Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-1728-5722

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